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Magnetic Resonance Imaging for Cerebral Micro-embolizations During Minimally Invasive Mitral Valve Surgery

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Abstract

The role of aortic clamping techniques on the occurrence of neurological complications after right mini-thoracotomy mitral valve surgery is still debated. Brain injuries can occur also as silent cerebral micro-embolizations (SCM), which have been linked to significant deficits in physical and cognitive functions. Aims of this study are to evaluate the overall rate of SCM and to compare endoaortic clamp (EAC) with trans-thoracic clamp (TTC). Patients enrolled underwent a pre-operative, a post-operative, and a follow-up MRI. Forty-three patients were enrolled; EAC was adopted in 21 patients, TTC in 22 patients. Post-operative SCM were reported in 12 cases (27.9%). No differences between the 2 groups were highlighted (23.8% SCM in the EAC group versus 31.8% in the TTC). MRI analysis showed post-operative SCM in nearly 30% of selected patients after right mini-thoracotomy mitral valve surgery. Subgroup analysis on different types of aortic clamping showed comparable results.

Clinical Relevance

The rate of SCM reported in the present study on patients undergoing minimally invasive MVS and RAP is consistent with data in the literature on patients undergoing cardiac surgery through median sternotomy and antegrade arterial perfusion. Moreover, no differences were reported between EAC and TTC: both the aortic clamping techniques are safe, and the choice of the surgical setting to adopt can be really done according to the patient’s characteristics.

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Abbreviations

SCM:

Silent cerebral micro-embolizations

MVS:

Mitral valve surgery

RAP:

Retrograde arterial perfusion

EAC:

Endoaortic clamp

TTC:

Trans-thoracic clamp

MRI:

Magnetic resonance imaging

3 T:

3 Tesla

DWI:

Diffusion-weighted imaging

DTI:

Diffusion tensor imaging

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Author information

Authors and Affiliations

  1. Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy

    Cristina Barbero, Mauro Rinaldi, Giovanni Marchetto, Erik Cura Stura, Marco Pocar & Massimo Boffini

  2. Department of Neuroradiology, Città della Salute e della Scienza, University of Turin, Turin, Italy

    Maria Consuelo Valentini

  3. Department of Neurology, Città Della Salute E Della Scienza, University of Turin, Turin, Italy

    Giovanni Bosco

  4. Department of Anesthesia and Critical Care, Città della Salute e della Scienza, University of Turin, Turin, Italy

    Claudia Filippini

  5. Cardiac Surgery Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy

    Davide Ricci

  6. Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy

    Davide Ricci

Authors
  1. Cristina Barbero
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  2. Mauro Rinaldi
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  3. Giovanni Marchetto
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  4. Maria Consuelo Valentini
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  5. Erik Cura Stura
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  6. Giovanni Bosco
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  7. Marco Pocar
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  8. Claudia Filippini
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  9. Massimo Boffini
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  10. Davide Ricci
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Corresponding author

Correspondence to Cristina Barbero.

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Ethics Approval

The study protocol was reviewed and approved by the Institutional Ethics Committee (protocol 0063123).

Conflict of Interest

The authors declare no competing interests.

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Associate Editor Angela Taylor oversaw the review of this article

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Barbero, C., Rinaldi, M., Marchetto, G. et al. Magnetic Resonance Imaging for Cerebral Micro-embolizations During Minimally Invasive Mitral Valve Surgery. J. of Cardiovasc. Trans. Res. 15, 828–833 (2022). https://doi.org/10.1007/s12265-021-10188-8

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  • DOI: https://doi.org/10.1007/s12265-021-10188-8

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